APPLICATION FOR WAITING LIST

Office Use Only
Date Receipted ______Paid $30 Y/N? ______Method of Payment ______
Surname of Child / Given Name:
Is the child known by any other name? / Date of Birth: / Sex: / M / F
Primary Language spoken at home: / Child’s Cultural Identity or Background:
Residential Address of Child:
Does your child have a Diagnosed Disability orDelay? (if YES, please attach copy of reports)
(This will not impact on your child being offered a position) / Yes / No
If YES, please briefly explain the needs of the child:
Do you have any concerns about your child’s development? e.g. speech, social, physical, behavioural, premature birth. / Yes / No
(Please explain)
Is your child from an Aboriginal & Torres Strait Islander background? / Yes / No
Do you have a family Health Care Card issued by Centrelink? (for low income families) / Yes / No
Preferred Year to Start (eg 2017, 2018, 2019):
Have you had another child attend Pennant Hills War Memorial Children's Centre? / Yes / No
Child’s Name / Year of Attendance:

(For information about our service, please view our Web Page at

Parent / Guardian / Carer (1)

Full Name:
Former Name: / Sex / M / F
Residential Address:
Home Phone: / Business Phone:
Mobile: / Email:
Cultural Identity or Background: / Primary Language Spoken at home:

Parent / Guardian / Carer (2)

Full Name:
Former Name: / Sex / M / F
Residential Address:
Home Phone: / Business Phone:
Mobile: / Email:
Cultural Identity or Background: / Primary Language Spoken at home:
A NON-REFUNDABLE ADMINISTRATION FEE OF $30 MUST ACCOMPANY THIS APPLICATION
(see next page for ways to pay)

Priority of Access

Enrolment positions are offered in order of the date of your child’s registration on the waiting list with priority given as per the Preschool Funding Model: i.e. 4 and 5 year olds, and 3 year olds from disadvantaged or ATSI backgrounds.

Position Offers

I understand that first round offers will be sent by email by the end of May of the year prior to starting Preschool for children who are eligible to attend formal school the following year. I understand that if I don’t reply, I will forfeit my position.

Cancellation of Position

I understand that if I fail to notify Pennant Hills War Memorial Children's Centre of any change of address and therefore do not respond to the position offer by the due date, my child’s place on the Waiting List will be cancelled.

Proof of Age and Immunisation

On acceptance of a position for my child at Pennant Hills War Memorial Children's Centre I understand that my child’s birth certificate and child’s immunisation record must be sighted.

Privacy

I understand that personal information collected or held at the Centre will only be used for the purpose for which it was collected or otherwise in accordance with the National Privacy Principles. Pennant Hills War Memorial Children's Centre will hold the information securely and will only disclose personal information in accordance with its Privacy Policy available from the Centre.

I understand that most children will start in the February of each year.

Signed: / Dated:
The $30 Waiting List fee can be paid
  • online BSB 032-087 A/c 730562 (please reference child’s name),
  • by Cheque to Pennant Hills War Memorial Children's Centre, or
  • in cash to the office
  • by credit card (Payment by credit card will incur a 1% surcharge)

Parent Survey

How did you find out about this Preschool?
Why did you choose this Preschool?

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